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目的:评价急诊经皮冠状动脉介入治疗(PCI)和静脉溶栓治疗对老年急性心肌梗死预后的影响。方法:我科203例老年AMI患者,32例患者接受常规治疗(对照组),98例接受静脉溶栓治疗(溶栓组),73例行急诊PCI治疗(PCI组)。比较3组血管再通率、左心室射血分数(LVEF)和病死率。结果:溶栓组梗死相关血管再通率为66.3%,PCI组为97.3%(P<0.01)。住院期间,对照组、溶栓组及PCI组间LVEF差异均有显著性(P<0.05)。3组患者住院期间病死率分别为9.4%、7.1%和4.1%,对照组与溶栓组、溶栓组与PCI组间比较差异不显著(P>0.05),但PCI组与对照组比较,P<0.05。溶栓再通和PCI成功患者住院期间LVEF和心肌缺血发生率(分别为16.9%和8.5%),差异均有显著性(P<0.05);住院期间病死率(1.5%和2.8%)无明显差异(P>0.05)。3组患者平均随访时间分别为(3.1±2.5)年、(3.6±2.4)年和(3.4±2.3)年,随访期间心梗再发率分别为23.1%、13.8%和7.4%,心肌缺血事件发生率分别为73.1%、55.2%和19.1%,需要再次行血运重建率分别为61.5%、42.5%和11.8%,LVEF值分别为0.456±0.121、0.568±0.132和0.615±0.115,病死率分别为15.4%、9.2%和5.9%,PCI组各项指标均优于对照组和溶栓组(P<0.05或P<0.01)。结论:老年AMI患者急诊PCI治疗的近期和远期预后优于溶栓治疗。
Objective: To evaluate the effect of emergency percutaneous coronary intervention (PCI) and intravenous thrombolysis on the prognosis of elderly patients with acute myocardial infarction. Methods: A total of 203 elderly patients with AMI in our department were enrolled in the study. 32 patients received conventional therapy (control group), 98 received intravenous thrombolytic therapy (thrombolytic therapy) and 73 received emergency PCI (PCI). Three groups of recanalization rate, left ventricular ejection fraction (LVEF) and mortality were compared. Results: The rate of vascular recanalization was 66.3% in the thrombolytic group and 97.3% in the PCI group (P <0.01). During hospitalization, there were significant differences in LVEF between control group, thrombolysis group and PCI group (P <0.05). The mortality rates of the three groups during hospitalization were 9.4%, 7.1% and 4.1% respectively. There was no significant difference between the control group and thrombolytic group, thrombolytic group and PCI group (P> 0.05). However, compared with the control group, P <0.05. The incidences of LVEF and myocardial ischemia during hospitalization for thrombolytic recanalization and PCI were 16.9% and 8.5%, respectively, with significant differences (P <0.05). In-hospital mortality (1.5% and 2.8% Significant difference (P> 0.05). The mean follow-up time was (3.1 ± 2.5) years, (3.6 ± 2.4) years and (3.4 ± 2.3) years in the three groups. The rates of myocardial infarction recurrence were 23.1%, 13.8% and 7.4% Incidence rates were 73.1%, 55.2% and 19.1%, respectively. The revascularization rates of reoperations were 61.5%, 42.5% and 11.8%, respectively. The LVEF values were 0.456 ± 0.121, 0.568 ± 0.132 and 0.615 ± 0.115, respectively. The mortality rate 15.4%, 9.2% and 5.9% respectively. The indexes of PCI group were better than those of control group and thrombolytic group (P <0.05 or P <0.01). Conclusion: The short-term and long-term prognosis of emergency PCI in elderly patients with AMI is superior to thrombolytic therapy.